Whether you want to praise the state of US medicine or find fault with it, you must begin by identifying its goals and asking how well it achieves them. June’s issue—Goals of Medicine: Decision Making at the Margins—looks at how difficult it can be for patients and physicians to agree on those goals. For example, what about patient requests for cosmetic surgery or a Ritalin prescription for a child who has not been diagnosed with attention deficit disorder. What about parents-to-be who ask medicine’s help to have a child of a specific sex. This issue also looks at the goals of medicine at the end of life, where individual expectations differ greatly and may even seem to “sideline” the traditional role of the physician.